Endometrial Cancer

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What is endometrial cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium.

Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called uterine sarcoma. About 80% of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early. According to the American Cancer Society, about 50,630 cases of cancer of the uterine body will be diagnosed in the U.S. during 2014.

What are risk factors for endometrial cancer?

The following have been suggested as risk factors for endometrial cancer:

Starting monthly periods before the age of 12

Late menopause

Infertility (inability to become pregnant)

Never having children

Obesity is a major risk factor for endometrial cancer.

Being treated with tamoxifen for breast cancer

Estrogen replacement therapy (ERT) for treatment of effects of menopause

Diet high in animal fat

Diabetes

Family history of endometrial cancer or colon cancer (hereditary nonpolyposis colon cancer)

Personal history of breast cancer

Personal history of ovarian cancer

Prior radiation therapy for pelvic cancer

Personal history of polycystic ovary syndrome or atypical endometrial hyperplasia

The risk for endometrial cancer increases as women get older and it is most common in white women.

What are the symptoms of endometrial cancer?

Consult a doctor if you experience any/all of the following symptoms:

Bleeding or discharge not related to your periods (menstruation). Over 90% of women diagnosed with endometrial cancer have abnormal vaginal bleeding.

Postmenopausal bleeding

Difficult or painful urination

Pain during intercourse

Pain and/or mass in the pelvic area

How can endometrial cancer be prevented?

The exact cause of endometrial cancer is not known, and there is no preventive medicine for it at for it at this time. However, doctors believe that avoiding the known risk factors, when possible, using oral contraceptives, controlling obesity, and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

How is endometrial cancer diagnosed?

Diagnosis includes a medical history and physical exam. It may also include 1 or more of the following:

Internal pelvic exam. This is done to feel for any lumps or changes in the shape of the uterus

Pap test (also called Pap smear). A test that involves microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. However, because cancer of the endometrium begins inside the uterus, problems may not be detected using a Pap test. Therefore, in some cases, an endometrial biopsy will be done. Doctors do not rely on the Pap test to screen for endometrial cancer.

Endometrial biopsy. A procedure in which an endometrial tissue sample is collected by using a small flexible tube that is put into the uterus. The tissue sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.

Dilation and curettage (also called D & C). Your doctor may recommend a D&C if an endometrial biopsy is not possible or if further diagnostic information is needed. This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.

Transvaginal ultrasound (also called ultrasonography). An ultrasound test using a small instrument, called a transducer, that is placed in the vagina. The doctor may do a biopsy if the endometrium looks too thick.

Treatment for endometrial cancer

Specific treatment for endometrial cancer will be determined by your doctor(s) based on:

Your overall health and medical history

Extent of the disease

Your tolerance for specific medications, procedures, or therapies

Expectations for the course of the disease

Your opinion or preference

The choice of treatment depends on the stage of cancer — whether it is just in the endometrium, or has spread to other parts of the uterus or other parts of the body. Most people with be first treated with surgery. Some may need additional therapy. Generally, treatment for people with cancer of the endometrium includes 1 or more of the following:

Surgery, including:

Hysterectomy. Surgical removal of the uterus.

Salpingo-oophorectomy. Surgery to remove the fallopian tubes and ovaries.

Pelvic lymph node dissection. Removal of some lymph nodes from the pelvis.

Laparoscopic lymph node sampling. Lymph nodes are removed through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly).